Direct oral anticoagulants are associated with lower risks in AF compared with warfarin

Scientists from the USA conducted a comparative study of the effectiveness and safety of direct oral anticoagulants (DOACs) and warfarin in patients with valvular atrial fibrillation (AF). The DOAC group demonstrated more favorable outcomes.

DOACs are increasingly being used instead of warfarin, but information about their effectiveness and safety in patients with valvular AF remains limited, according to an article from the Annals of Internal Medicine. An earlier systematic review found that DOACs were more effective among patients with AF over 65 years of age, the authors noted.

A new retrospective study included insurance data on 56,000 adult patients with AF. In the period 2010–2019, half of them started using DOACs for the first time, the rest started using warfarin.

When assessing the effectiveness of the drugs, the scientists compared the incidence of ischemic strokes and systemic embolism between the two groups. The risk of these events was significantly lower in the DOAC group (hazard ratio (HR) = 0.64), where there were 787 events, compared with 1211 in the warfarin group.

In terms of safety, the prevalence of significant bleeding – intracranial and gastrointestinal – was considered. Their risk was also significantly lower among those taking DOACs (RR 0.67), with 1465 patients experiencing significant bleeding in this group, and 2155 in the warfarin group.

These efficacy and safety results were true for individual drugs from the DOAC group – apixaban and rivaroxaban. Dabigatran also showed similar results for significant bleeding but not for efficacy.

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